Case Summary: Implants, Grafting, and Membrane on a Fibromyalgia patient

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Case Summary: Implants, Grafting, and Membrane on a Fibromyalgia patient

State: Minneapolis, MN

Amount Billed: $14,942.00

Amount Paid: $11,042.00

Insurance Carrier Billed: United Healthcare

The patient presented with significant bone atrophy and several missing teeth. The patient suffers from Fibromyalgia.  

Due to the patient’s Fibromyalgia condition and thorough documentation from the provider, the medical insurance paid $11,042 of the $14,942 claim.  Leaving the patient with a much more reasonable out-of-pocket portion of $3,900.  

The practice billed their full usual, customary, and reasonable out-of-pocket fees (UCR), even though they are contracted with most dental plans, and therefore were able to collect 100% of their FULL FEE between the patient and medical insurance coverage. 

Without medical insurance, the patient would have been limited to their $1,500 max dental benefit and the practice would have been subject to their dental PPO fee adjustments and would have collected approximately $10,869 at the reduced fee schedule, and the patient would have owed $9369 out of pocket.  

So not only did the patient save $5,469 because medical insurance was billed, the practice collected an additional $3,623 that they would not have collected had they not billed medical insurance. 

In stories like these, everyone wins. Patients may not be able to afford that $9,300 for dental services, but the $5,400 in savings can make even a hesitant patient proceed with treatment. Had the practice not billed medical insurance, and the patient chose not to move forward with their treatment, the practice would have made nothing. 

The length of time it takes to get paid after billing medical insurance is the main holdup for many dental offices, they’ve fallen for the rumor that it can take 6 months or longer to get medical insurance to pay up. While this may be true in rare cases, most medical claims are paid much faster. 

The service was completed on 10/28/2022 and submitted to Imagn billing on 10/31/2022, the explanation of benefits (EOB) date is 12/2/2022. This claim was processed and paid within 32 days of submission. 

Contact us at (855) 534-1433 or to see how we can help you get more success in billing medical insurance for Dental procedures! 

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